1. B y : J i n y e o b K i m
The Elderly with Heart Disease
and Exercise

2. Facts About Heart Disease
 Cardiovascular Disease (CVD) is more common among men
than women in every age group.
 In the United States, a quarter of the total deaths (each
year) is attributed by heart disease.
 With about 66% of these heart disease deaths occurring within
the population of 75 years old and older.
 About 83.6 million Americans have some kind of heart
disease.
 With about 42.2 million out of this population is 60 years old
and older.

3. Facts About Heart Disease
 The most common type of heart disease is the Coronary
Heart Disease (CHD) – attributes to more than 370,000
deaths each year in the United States.
 With about 80% of CHD deaths occurring within the
population of 65 years old and older.

4. What Causes Heart Disease?
 Although the term - heart disease – may relate to various
problems associated with the heart and blood vessels, the
term generally refers to the damage of the heart or blood
vessels caused by atherosclerosis.
 Atherosclerosis is the most common cause for heart disease.
 Atherosclerosis refers to the fatty plaque buildup within the
arteries. The plaque buildup causes clotting and hardening of
the artery walls. Thus, progressively narrowing the inside of
the artery. Therefore, the plaque buildup may cause an
obstruction of blood flow from the arteries to the organs and
tissues.

5. Atherosclerosis

6. Heart Disease Risk Factors
 About half of the American population diagnosed with
heart disease tend to have at least one of these primary risk
factors:
 High blood pressure
 High LDL cholesterol
 Smoking
 Other risk factors that may also attribute to higher chances
of heart disease:
 Excessive alcohol consumption
 Poor diet
 Diabetes
 Overweight/Obesity
 Physical inactivity

7. Range of Motion Exercises and Heart Disease
Recovery
 Patients should have a meeting with a exercise physiologist,
physical therapist, or nurse clinician every day during the
recovery process.
 Stretching or range of motion (ROM) exercises of upper- and
lower- extremity highly recommended for inpatients.
 Myocardial infarction (MI) patients highly recommended to begin
stretching exercises as early as 2 days after MI.
 Coronary artery bypass graft (CABG) surgical patients highly
recommended to begin stretching exercises as early as 24-hours after
the surgery.
 The CABG surgery may damage the soft tissue and bone of the chest
wall, and result in the deterioration of muscle function without ROM
exercises.

8. Range of Motion Exercise
 A new ROM inpatient program, focusing on the recovering
patients, should include the following:
 ROM exercises performed once a day during the meeting with a
physician.
 Each ROM exercise session should target both the upper- and lower-
extremities.
 Upper-Extremity include:
 Shoulder flexion, abduction, and internal and external rotation
 Elbow flexion
 Lower-Extremity include:
 Hip flexion, abduction, and internal and external rotation
 Plantar flexion and dorsiflexion
 Ankle inversion and eversion
 1 set of 10 to 15 repetitions should be performed for each exercise
within the ROM exercise session.
 Exercises should feel light to somewhat hard (RPE: 11 to 13).

9. Maintenance Exercise and Heart Disease
 The types of exercises that are beneficial for heart
disease patients should focus on strengthening the
muscular and cardiovascular systems of the body.
These are:
 Endurance training (Aerobic exercise)
 This type of exercise improves the heart’s functional
capacity.
 Includes: cycling, walking, running, swimming, and etc.
 Resistance training (Anaerobic exercise)
 This type of exercise improves neuromuscular function
and increases lean body mass. Also, the increase in
muscle strength is related to the decrease in blood
pressure and heart rate, while lifting.
 Includes: “pumping iron,” or exercises that improve
muscle strength and endurance.

10. Maintenance Exercise and Heart Disease
 A study has shown that an exercise-based cardiac
rehabilitation for heart disease patients is linked to a
significantly lower risk of mortality, within a 5-year follow-
up.
 Exercise in heart disease patients has been shown to
improve functional capacity by 10% to 60% within the first
12 weeks of training.
 Exercise in heart disease patients has been shown to reduce
myocardial work during workloads by 10% to 25% within
the first 12 weeks of training.

11. Maintenance Exercise and Heart Disease
 CABG surgery and sternotomy patients is to avoid sternum-
pulling resistance exercises for the first 3 months.
 MI patients is to avoid resistance exercise for the first 2 to 3
weeks.
 Prior to beginning either endurance or resistance training,
the patient should meet a healthcare professional for an
evaluation.

12. Resistance Training
 A new resistance training program, focusing on the elderly
with heart disease, should include the following:
 Resistance exercises performed 2 to 3 days each week.
 Each resistance exercise session should include 8 to 10 various
exercises that target the major muscle groups.
 Include: leg press (quadriceps), leg curls (hamstrings), calf raises
(calves), lower back extensions, pull downs (upper back), chest press,
shoulder press, triceps extensions, and biceps curls
 1 set of 10 to 15 repetitions should be performed for each exercise
within the resistance exercise session.
 Exercises should be performed at a lower-intensity level to prevent
injuries (RPE: 12 to 13).
 Weight machines are recommended, and free-weights are
discouraged.
 The elderly tend to have a lack of balance, lower-back pain, poor
vision and a higher tendency to drop weights unintentionally.

13. Resistance Training
Variable Resistance Training Effect
Bone mineral density level Moderate increase
Body fat percentage/
Lean body mass
Slight decrease/
Moderate increase
Muscle strength Great increase
Insulin response to glucose/
Insulin sensitivity
Moderate decrease/
Moderate increase
LDL cholesterol Slight decrease
Resting blood pressure
(Systolic/Diastolic)
No effect/Slight decrease
VO2max Slight increase
Resting heart rate/
Stroke volume
No effect/
No effect

14. Endurance Training
 A new endurance training program, focusing on the elderly with heart
disease, should include the following:
 Endurance exercises performed 3 to 5 days each week.
 Each endurance exercise session should attempt to incorporate both the lower-
and upper- extremities.
 Upper-Extremity include:
 Arm ergometry
 Lower-Extremity include:
 Walking, stairclimber, and jogging/running
 Combined include:
 Rowing, cross-country ski machine, combined arm/leg cycle, swimming, and
aerobics
 A duration of 6 to 30 minutes should be performed within the endurance exercise
session.
 Exercises should be performed at about 55% maximum heart rate (HR) or at
about 40% peak oxygen uptake (VO2).
 Seated machines are recommended, and standing machines are discouraged.
 The elderly tend to have a lack of balance.

15. Endurance Training
Variable Endurance Training Effect
Bone mineral density level Moderate increase
Body fat percentage/
Lean body mass
Moderate decrease/
No effect
Muscle strength No effect
Insulin response to glucose/
Insulin sensitivity
Moderate decrease/
Moderate increase
LDL cholesterol Slight decrease
Resting blood pressure
(Systolic/Diastolic)
Slight decrease/Slight decrease
VO2max Great increase
Resting heart rate/
Stroke volume
Moderate decrease/
Moderate increase

16. References
 Go A. S., Mozaffarian D., Roger V. L., et al. (2013). Older Americans &
Cardiovascular Diseases. American Heart Association. Retrieved from:
http://www.heart.org/idc/groups/heart
public/@wcm/@sop/@smd/documents/downloadable/ucm_319574.pdf
 Pollock, M. L., Franklin B. A., Balady G. J., et al. (2000). Resistance Exercise in
Individuals With and Without Cardiovascular Disease. AHA Science
Advisory, 101, 828-833. Retrieved from:
http://circ.ahajournals.org/content/101/7/828.long
 Shephard R. J. & Balady G. J. (1999). Exercise as Cardiovascular Therapy.
Clinical Cardiology: New Frontiers, 99, 963-972. Retrieved from:
http://circ.ahajournals.org/content/99/7/963.long